Individual
DR. JOSE MATHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 PORT ARTHUR TER, LEESVILLE, LA 71446-4635
(337) 392-2211
(337) 392-2210
Mailing address
1101 PORT ARTHUR TER, LEESVILLE, LA 71446-4635
(337) 238-1517
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
11538R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11538R
STATE LICENSE
LA
05
—
1675024
—
LA
01
—
P00225923
RAILROAD MEDICARE #
LA
Enumeration date
03/17/2006
Last updated
01/23/2014
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